Learning Together from Practice Multi-Agency Audit Overview Report

Learning Together from Practice Multi-Agency Audit Overview Report April 2013 1

Contents Page number Introduction 3 Terms of Reference 4 Methodology 5 Section 1 - Learning about process 7 Section 2 - Learning about practice 12 Moving Forward 22 2

Introduction The Board led on a multi-agency case audit which took place between January March 2013 and involved a large number of safeguarding partner agencies. This report provides a summary of what we collectively did and of what we learnt, about practice and about the process. Successive HSCB Business Plans have set out an agreed intention to establish multi-agency case audit processes. The requirement to do so was also described in the announced inspection of safeguarding in 2011. Working Together 2013 also requires LSCBs to lead reviews or audits of practice in one or more agencies. We used multi-agency case audits to describe our process, mainly because this language was well-understood locally. Audits of this kind can take many different forms, but are often associated primarily with auditors examining case records as the sole means of assessing practice and outcomes. We understood collectively that we would derive much more learning about how professionals work together and about the impact of their work if we built in to the process, as core principles, the following elements: o An expectation that auditors would involve practitioners and decision-makers directly in the initial practice review process so that it became a done with rather than done to exercise and in order to yield a more in-depth understanding of practice issues and the working context of practitioners. o An opportunity for children and families to meet with an independent person to talk about their experiences of the help and support provided to them o A semi-structured, facilitated conversation with the group of practitioners involved in each case, to create the opportunity for joint reflective learning. In this way, this process was wider in scope than some traditional multi-agency case audit processes. In the future we are likely to use different language to describe these processes (for example, protected learning, learning from practice, learning and improvement ). 3

Terms of reference This multi-agency audit will inform the work of the Quality Assurance and Performance Management sub-committee as part of an over-arching quality assurance framework. The terms of reference, agreed audit tool and methodology for learning and improvement were agreed by a small multi-agency working group. The criteria agreed for the case selection were: Children currently subject to a Child Protection Plan, and The case had gone beyond its second Review Child Protection Case Conference. One case was selected from each of the three Children s Social Care Locality Teams. The purpose of this multi-agency audit was to identify areas of good practice, areas for development or areas of concern in relation to the way in which agencies are working together to help keep children safe in Hull. Working Together 2013 sets out clearly that Local Safeguarding Children Boards should Quality assure practice, including through joint audits of case files involving practitioners and identifying lessons to be learned Section one of this report explores lessons learned about the audit process. This will inform future learning and improvement activity. Section two is a triangulation of information from: completed audit tools; learning from practice events, and family feedback It aims to highlight examples of both good practice and barriers to effective multi-agency working to safeguard children. 4

Methodology Three cases were randomly selected in December 2012 from the Care First System. Agency involvement was then identified through a review of the invitation and attendance lists to both the Initial and subsequent Review Case Conferences. With only three cases chosen to pilot this HSCB multi-agency audit, there was an acknowledgement that learning might be limited. However it was agreed as an appropriate way to trial a new methodology in order to provide a window onto the safeguarding system. Individual HSCB members were notified of their own agency involvement in the cases in December 2012. They were asked to nominate an appropriate auditor from within their own service to undertake the audit. Having an internal auditor from each organisation was seen as an advantage. They would have a good understanding of internal policies and procedures, and would be able to identify the organisational context in which practitioners were working. They would also in a position to act promptly on any areas of concern that were identified. The agencies involved in this multi-agency audit covered a wide spectrum, and included: Children s Social Care; Health organisations, Voluntary sector agencies; Humberside Probation Trust; Humberside Police; Schools; Children s Centres; Substance Misuse services and Domestic Violence services. A comprehensive set of guidance notes were produced and an Auditors Briefing session facilitated by the HSCB in January 2013. The briefing was designed to provide detail of the multiagency audit process, the paper tool and the timescales for completion. The importance of a conversation with the frontline practitioner involved in the case was described as being an essential element in the completion of the audit. Auditors were asked to complete a set of questions and make a judgement about whether there were: 5

areas of good practice (Green); areas for development (Amber); or, areas of concern (Red). Following the completion and return of the audit tool, separate auditor and practitioner feedback sessions were facilitated by an agency independent of the process and supported by HSCB Professional Practice Officers. The sessions aimed to bring together those involved in a multi-agency forum in order that the HSCB could: Receive feedback about the audit tool and process; Develop a fuller picture of the context in which practitioners work, both individually and in partnership; Explore the strengths and barriers to working together; and Establish opinion about the provision of good quality support and supervision to front line practitioners. In order to enrich the information gathered from both the paper audit, and the practitioner feedback sessions, where appropriate, conversations with parents / carers and children were undertaken by Hull Safeguarding Children Board Professional Practice Officers. 6

Section 1 Learning about process Identification of cases The following additional criteria should be considered in all future routine learning and improvement activity: Cases that have been subject to recent external scrutiny should be excluded; and Due consideration should be given to the potential impact of any multi-agency learning and improvement activity on: o Current criminal or civil proceedings; and o Current formal complaint proceedings. The scope of the audit was recognised as being too wide. It was suggested that looking at a snapshot of time could lead to a more thorough and consistent audit. Not all agencies / organisations that were involved in the case were identified from the conference minutes. Additional agencies became known to HSCB through discussions with lead practitioners and also with family members. Communication Overall, both auditors and practitioners involved felt that where they had direct communication with HSCB they were clear about their role within the audit process and felt well prepared to participate. This was either through communication with their individual Board member, or contact with HSCB Professional Practice Officers (HSCB PPOs) There is feedback to suggest that within some organisations there was significant delay in the cascade of information from Board member to auditor and in turn frontline practitioner. This led to some auditors feeling poorly prepared and some frontline practitioners feeling confused and anxious about their involvement. In some cases frontline practitioners explained that they had not been informed that a multi-agency audit was taking place until 7

receiving the invitation from HSCB to a multi-agency practitioner feedback session. This clearly indicated that these practitioners had not contributed to the learning process within their own organisation. The importance that front line practitioners placed on the face to face approach of their auditor was described in the feedback sessions. They valued the opportunity for protected time to talk about their work with someone (often) more senior in their organisation. Due to a number of auditors being unable to attend the multiagency briefing session, an additional 8 single agency briefing sessions were delivered. 21 of the 22 agencies included in the audit were represented at one of these pre-audit briefing sessions. Feedback described these sessions as beneficial for exploring concerns and questions about the practical application of the tool. However, the additional sessions proved extremely time-consuming for Board Officers. Where an organisation sent a representative, rather than the person who was due to complete the audit, this resulted in confusion about process and resulted in additional work being undertaken to support the organisation with the completion of the task. Both auditors and frontline staff were positive about the offer of ongoing support and guidance from the HSCB PPOs where it was taken up. Audit tool Where frontline practitioners contributed to and were engaged in the audit, there is a clearer picture of how children are being safeguarded and how agencies are working together to do this. Where there was a lack of consultation with frontline practitioners it is evident that the audit process is not complete and the analysis lacking in depth. There was considerable variability in the quality and depth of audits. Some audits were partially completed or a response of N/A 8

given to a relevant section with no explanation. This provided some difficulties in reviewing audits in a multi-agency context. Where auditors were able to submit a draft version in advance of the deadline, feedback on improvements could be provided by Professional Practice Officers. However those submitted closer to or after the deadline had to be left incomplete due to timeframes. Not all auditors used the RAG rating system consistently. Feedback from auditors suggested that there was not enough guidance provided about what Red, Amber and Green meant and that this could be very subjective. There was a suggestion that there could be a workshop in which auditors could practice the use of the tool attached to a case study. Some auditors indicated that they were not aware of or did not use the guidance notes attached to the tool. Individual auditors were given the freedom to complete the tool in a way that suited their service. Frontline practitioner feedback described an appreciation of the time that auditors invested in preparing for the conversations with them. Feedback from the auditor session requested that any future learning and improvement work be mindful of the amount of auditor time that this preparation had taken. Where small Voluntary Sector agencies were involved, the identification of an appropriate auditor without direct experience of the case was more challenging. Some organisations felt that the questions within the audit tool were social care orientated. Whilst this might be appropriate when learning lessons about those cases involved in the Child Protection system, the language used in future multi-agency learning and improvement activity will need to be considered carefully. 9

Multi-agency auditor and practitioner feedback sessions The multi-agency auditor and practitioner feedback sessions enabled a greater exploration of the good practice, successes and challenges of multi-agency working than was evident within the paper audit alone. There was a level of anxiety expressed by both auditors and practitioners about being involved in a learning and improvement event led by HSCB. However, having attended sessions, front line practitioners described a sense of relief and reassurance at having come out of the other side of the process. Having the spotlight on practice was viewed as being positive in helping reflective practice. Feedback from the practitioner sessions was particularly positive about the way in which difficult multi-agency conversations were managed in an informal and sensitive manner. There was 50% (18 /36) attendance at the practitioner feedback sessions. Non attendance by key individuals or agencies will have limited the meaningful discussion of some of the issues raised. Reasons for non attendance included we don t always check e- mails, time constraints competing priorities and lack of appropriate notice of dates. Where individuals / agencies did not attend a feedback session, a questionnaire was e-mailed out; this provided a further opportunity to express views. However there was a very limited response (4 / 18). Recommendations for future learning and improvement activity HSCB should continue to be mindful of other internal and external audit activity and take account of the impact of these in the timing of future learning and improvement activity. Taking on board the feedback from both auditors and practitioners, the size and complexity of any future audit tool will be reduced to a 10

size proportionate to the audit activity taking place. This will also allow proportionately more space and time for the conversation. Agencies requested a standardised action plan at the end of the audit tool where they could identify and monitor service specific learning. A narrower more in-depth focus was suggested when agreeing the terms of reference and scope of future learning and improvement activity. This is also consistent with systems thinking. However decisions will need to be proportionate to the nature of each learning and improvement theme. There was a strong recommendation that there needs to be improved communication in the cascading of information from individual Board members throughout their own organisations. G.P. s chose not to engage in the multi-agency audit process, despite having involvement with all three families. This was seen by all organisations involved as a significant gap in the information provided. The HSCB needs to consider how to engage G.P. s in future multi-agency learning activity. HSCB needs to publish and publicise more information regarding quality assurance and performance management so that staff across agencies can be more familiar with this function of the Board this would also need to be promoted by individual Board members throughout their own organisation. 11

Section 2 Learning about practice This section of the report draws together some of the over-arching themes which have been identified through the three parts of the audit process completed and returned audit tool, multi-agency auditor and practitioner feedback sessions and conversations with families. Where an individual audit highlighted an area of development and / or of concern, HSCB Officers have sought assurance that any issues identified have been followed up and addressed by the individual agency /organisation. Feedback from families is threaded throughout this section of the report and provides an insight and depth of understanding into how families experience multi-agency working making a contribution to keeping their children safe. It is important to note that in all three cases identified as part of this audit, all adult family members knew the reason why their child/children were subject to a child protection plan. They were all clear about which agencies were involved and what they were individually and collectively trying to do to support their family. Communication Good communication between agencies resulted in clarity of agency role and a thorough understanding of which part of the plan agencies were responsible for. This in turn provided reassurance for families that agencies were working together for them. The chart below highlights that, when describing what worked well, communication and information sharing between agencies was described as significant. 12

What worked well? Good support from lead agency, 3 Clear accountability in terms of roles and responsibilities, 1 Co-ordination of support, 2 Prompt response to child protection concerns, 1 Good chairing of conferences, 1 Comminuation and information sharing between agencies, 14 open and honest relationship with family, 2 Practitioners indicated that they valued face to face communication rather than telephone contact to share information. Communication improved when there were positive working relationships between agencies. One of the challenges identified by practitioners was in maintaining timely communication about significant changes to the plan, particularly when Core Group meetings were cancelled. Both front line practitioners and family members valued consistency of practitioner. Where there were multiple workers involved from the same service this tended to complicate communication. I know I don t need to, but I feel that I have to explain to the contact officer why I am having supervised contact with my own kids. When there are lots of different contact officers this is difficult for me and the kids There was an acknowledgement from some services that communication had not always been directly with the family but had instead relied on the Lead Social Worker. The learning for some agencies described that in the future, a more assertive approach to working directly with individual family members may result in improved engagement in services. 13

Family members reflected the importance of being able to access timely support. The following provides valuable insight into what was important to them about the way that agencies communicated and responded: when I needed some help with my eldest sons behaviour which was out of hours it was eventually the Police that responded and they were brilliant I can talk to the social worker and feel listened to but sometimes they are hard to get hold of and don t return calls I can call her anytime and if I have got no credit I can text her and she will call me back - mother talking about her Social Worker The social worker kept in touch and supported us, gave us a direct number to contact her on if there were any difficulties this reduced the anxiety of the family in a difficult situation. The Social Worker comes to my house and plays with me, sometimes we draw and she brings jigsaws. I like jigsaws. One child describing how his Social Worker makes him feel important. One child described his method of communicating his feelings with his Women s Aid worker by having thumbs up, thumbs down and thumbs in the middle system as he doesn t always want to speak. it is important that my daughter is still treated as a member of a family even though she is in prison Family members also described the importance of professionals communicating with them with openness and honesty, particularly at times where there was difficult information or decisions to share. the Social Worker was down to earth and would always tell me straight and this is really important 14

Early identification and thresholds of need The exploration of historical agency involvement has clearly highlighted some of the challenges faced by both practitioners and family members when considering early identification and engagement, particularly when a family have some additional needs but do not yet meet the criteria for statutory intervention. Both universal and specialist services identified a number of missed opportunities for both early intervention and possible earlier identification of child protection concerns, had practitioners shared the correct information in a timely fashion. Some agencies described families as difficult to engage prior to the child protection referral that lead to the Child Protection Plan, indicating that it was challenging to complete any kind of in-depth assessment of strengths and needs. Schools can hold valuable historical information about families and sometimes their heightened level of concern following a slow escalation was not always seen as being taken on board by Children s Social Care. Families shared their views around early support, saying that: if there had been more help and support from services before it got to the point where the children were on a plan that would have been better but I have always relied on family rather than asking for outside help I tried to get help before social services got involved and I knew me and the children needed support but when I rang I was told I did not meet the criteria. Things were not bad enough for me to get any help but when my husband was living with me they were soon at my door With regard to the HSCB threshold of need guidance, the results of the audit show an inconsistent understanding and use of the thresholds of need guidance as detailed in the chart below. 15

Were the HSCB thresholds of need guidance / training used to inform decision making? No 10% Unsure 10% Not RAG rated 64% Yes 16% The thresholds of need document was first published in September 2011 which would have been at around the same time that the first child protection conferences were held for each of the cases audited. There has since been a significant amount of work done to embed thresholds into practice and to evaluate impact. There will be a need in future audits to re-visit agency understanding of thresholds to evidence how this has been embedded. When exploring the issue of missed opportunities which were identified within the audit, practitioners describe a changing culture and an increased confidence in both the identification of risk and protective factors and indicators of possible harm, and also an increased understanding of the mechanisms for challenging decision making around thresholds for referrals into children s social care. Referral and assessment Through the paper audit, agencies identified that when the presenting child protection concern came to light, information was shared appropriately and timely referrals were made to Children s Social Care and that these received an appropriate response. However, the outcome of referrals to Children s Social Care was not always shared in writing with the referrer. There was recognition that, on occasion, other agencies could also have done 16

more to find out the outcome of the referral, rather than just rely on feedback from Children s Social Care. Not all agencies felt that their views were seen as being taken into account in the initial assessment, but in all cases professionals felt that they were listened to when it came to the planning stage. Meetings Overall, both agency and family feedback indicated that all felt that they had the opportunity to have their say at the Initial Child Protection Conference, subsequent Review Conferences and also at Core Group meetings. Throughout the audit process agencies described how they valued the Independent Chair of the conference in helping keep the case focussed. Family members in each case referred to the Independent Chair by name and described them as being approachable. I feel able to talk with the chair of the conference and I think they have a good understanding of all the issues and do not want the children to stay on the plan if they don t need to be on it There was a recognition within both the Independent Conferencing and Reviewing Team and individual agency audits that not all agencies submitted formal reports ahead of either Initial or Review Case Conferences. In two of the cases, the date for the first Core Group meeting was not set at the end of the Initial Case Conference. In both cases, this was because the Lead Social Worker who would have been responsible for co-ordinating Core Groups was not present at the meeting. It was identified that in some cases there was a marginal presence of adult services both at Child Protection Conference and Core Groups, where their input would have greatly improved information sharing and care planning. Regular Core Groups were described by both agencies and family members as being an important way of sharing information face to face and keeping up to date 17

Everybody who comes says what they think, if I need anything like help with my sons sleep, I can talk about it we meet once every few weeks and it is a catch up about how the children have been a mother talking about her experience of core groups. The Child Protection Plan was not always made available to all agencies attending Core Groups. This meant that it was often difficult to monitor progress of actions and that the plan was not always up to date and SMART. There was an acknowledgement that minutes were not always available following Core Groups. This meant that some agencies found it difficult to stay up to date with often rapidly changing circumstances, particularly if they were unable to attend the meeting. However there was recognition of a lack of administrative support available to Social Workers in being able to produce formal minutes. Management oversight Supervision and management oversight was identified within 16 individual agency audits as being an area of good practice. During the multi-agency feedback sessions, when asked the question What support is in place to enable you to feel confident within your own organisation and working with others?, frontline practitioners also highlighted that they valued good quality regular supervision as a key factor in helping them to feel confident in their practice. 18

What support is in place to enable you to feel confident within your own organisation and working with others? Case audit, 2 Peer support, 5 Policies and procedures, 4 Access to relevant training, 2 Good quality regular supervision, 6 Being able to contact other agencies for advice, 4 There was some evidence of good management oversight identified throughout the audit process. However, the recording of key decision making was not always evident in the paper audit. On occasion there were actions that had been recommended and agreed in relation to case management which had not been implemented in a timely fashion in practice. Although it was recognised that there was management oversight from most agencies which reflected good practice, the recording of this and the decision making around it was not always evident in the paper audit. The importance of documenting key decisions has been reinforced through this reflection by those involved in the multi agency feedback sessions. The importance of relationships From the independent conversations with family members there was a strong emphasis on the importance of the relationships that they had developed with professionals. This section of the report tries to capture some of these reflections below. Despite a sometimes turbulent relationship with the Social Worker, both the individual support provided and the coordination of 19

support that the Social Worker offered was valued by all family members. we received excellent support from the Social Worker All family members felt they were treated with respect I do not agree with some of the things that have been put in place but I have been able to tell someone that I am unhappy about it and have felt that I was listened to with respect One child said that he was able to tell his Social Worker good things about home and school, sometimes because she asked him but other times because he wanted to tell her. He could also talk to her about unhappened things which seemed to be an explanation for the things that weren t so good that happened in his life. Strength to Change helped me sort out my issues around anger and domestic violence I know that they know more than me and that I am not a guinea pig she completely changed me, I don t know how she did it, she waved a magic wand or something a mother talking about her probation officer she is a rock and did absolutely loads for me a mother talking about her Domestic Abuse Partnership worker. my worker from Minerva is my main source of support and works with me both inside and outside of prison a mother who particularly valued professional visits in prison I know the days she is coming, even if I don t want to talk to her its still ok for her to come Child talking about his women s Aid worker One child described his experience of school positively when he talked about the teacher helping him to know the rules and the consequences of him doing something silly. I can tell her anything Child talking about the support his teacher offered him if something happened that he was worried about. 20

Is there any evidence that inter-agency working has helped make this child safer? The above question was one of the most significant asked as part of this audit. In the majority of audits agencies felt that by working together they were helping to keep children and families safe as demonstrated by the table below. Is there evidence that inter agency working has helped make the child safer? 25 20 15 10 5 0 Red Amber Green Not RAG rated The three audits which highlighted this as an area of concern did so as a result of the agency having neither sought or received any feedback as to a reduction in the level of risk to the child/children. For those agencies that highlighted this as an area of good practice, good communication between agencies is a key feature of how front line practitioners believe that the work they are involved in is contributing to keeping children safe. Formal meetings (Case Conferences, Core Groups, MARAC) and informal methods of communication, where positive professional relationships have promoted the timely sharing of information have both been referenced. The professionals involved also made links between the level of engagement of the family with services equating to an increased confidence in the child s safety. 21

There is some evidence from the family feedback of how they perceived the impact of agencies working together. if social services hadn t got involved our grand daughter would not exist now And we are very different people now to who we were then When talking about the difference that services have made one mother said that my eldest son s behaviour is more settled and I feel more confident in managing his behaviour. It is, nevertheless, interesting to note that agencies collectively found it difficult to provide concrete, simple evidence that children are safer as a result of inter-agency working. Moving forward This audit tested out a model to inform future learning and improvement activity. As there were only 3 cases reviewed there was an acknowledgement that learning might be limited. However where there have been areas for development identified, agencies consistently reported having made individual organisational and personal changes as a result of the audit experience. Working Together 2013 (p65) outlines principles for continuous learning and improvement stating that all professionals and organisations with responsibility for protecting children need to reflect on the quality of their services and learn from their own practice and that of others. In order to support agencies to fulfil this role the LSCB should maintain a local learning and improvement framework which is shared across all local organisations. Future multi-agency audits will continue under the HSCB quality assurance and performance management framework. Future audit activity will take on board the feedback and suggestions from this process. 22